Release of Responsibility for Leave of Absence
Use this form to document patient/resident/representative's acknowledgement that they release facility, staff and attending physician from any responsibility while resident is away.
Also acknowledges that a bed will be reserved for the resident upon return by a specified date.
Download a sample today!
Also acknowledges that a bed will be reserved for the resident upon return by a specified date.
Download a sample today!
Size: 5 1/2" x 8 1/2"
Print: Black Ink, One Side
Paper: White
Packaging: 100 per pad
Print: Black Ink, One Side
Paper: White
Packaging: 100 per pad